Healthcare Provider Details

I. General information

NPI: 1306760293
Provider Name (Legal Business Name): MADELINE M GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W AIRLINE HWY STE D
LA PLACE LA
70068-3825
US

IV. Provider business mailing address

841 27TH ST
KENNER LA
70062-5164
US

V. Phone/Fax

Practice location:
  • Phone: 985-234-4035
  • Fax:
Mailing address:
  • Phone: 504-402-7716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: